Book Notes: A grim, scientific look at addiction

Wednesday

The book cover of “Never Enough: The Neuroscience and Experience of Addiction,” by Judith Grisel, displays the two words of the main title - Never Enough - in a vertical column, strong and clear at the top but relinquishing focus as the words blur and merge and fade. It is a clever bit of graphic art that conveys a sense of dissolution. This book is essential but it is best absorbed slowly. I confess to wanting whiskey as I read, wanting to mute the findings. As I moved beyond the cover to the text, I confronted the story of the substance abuser’s sure, slow slide to oblivion.

Addiction in the United States is epidemic and catastrophic, writes Grisel. At most, 10 percent of substance abusers can stay clean and/or sober for any appreciable time. “One has about twice as good a chance of surviving brain cancer,” she writes. The realities of pervasive addiction in this country are shocking.

Grisel is a behavioral neuroscientist who, for the last 30 years, has researched the biological basis for addiction to drugs and alcohol. For 10 years, between the ages of 13 and 23, she used just about any mind-altering substance she could find or was offered. She started with alcohol and moved on to try anything. Marijuana was her most beloved drug and the hardest to resist. It took nine years for Grisel to stop craving pot. She was an enthusiastic imbiber, more than comfortable with most altered states, and therefore predisposed to the addictions that quickly ensnared her.

As the subtitle of her book says, she presents a comprehensive picture of the science and experience of addiction. One of a handful of books that looks at addiction personally and scientifically, “Never Enough” stands out because of its candor and its relevance. Addiction rates are on the rise around the world despite what scientists have learned. Substance abuse affects 1 in 5 over the age of 14 in the United States. A quarter of all deaths are due to excessive drug use.

Genetics plays a role, as do other factors including developmental influences and environmental input. Studies have shown that those with a parent who abused substances are 50 to 60 percent more likely to become addicted. But the age at which one starts abusing addictive substances and the environmental cues that trigger cravings are significant factors in the addictive process.

One of the most interesting sections of Grisel’s book has to do with what she calls the third law of pharmacology: The brain adapts to all drugs that affect it by counteracting the effect. In other words, the brain isn’t a passive receptor but an actor with unrelenting agency. In fact, it works to restore homeostasis by facilitating the opposite state. Getting high is a relatively short-lived experience, says Grisel. It doesn’t take long before the purpose of the drug or alcohol use is to stave off the effects of withdrawal. Putting it in Newton’s terms, “who goes up must come down.”

The more frequent the stimuli, the faster, bigger and longer lasting the brain’s counter response resulting in the reduction of the drug experience (tolerance) along with withdrawal symptoms and cravings when the substance isn’t available.

Each chapter covers an addictive substance and includes stories from Grisel’s own experience as an abuser. There is enough science in each chapter to make clear how the drug works and how the body responds. Each substance affects discrete parts of the brain except for alcohol, which Grisel calls the “sledgehammer” because it’s indiscrete and, as such, harder to study and understand.

Opiates, she writes, “bestow utter contentment” … at first. And those who know or have known enthusiasts of opioids know this: “Everything superfluous to the relationship (between the opiate and the user) recedes to a distant horizon.” The brain’s counterpunch, it’s efforts to achieve homeostasis, is brutal. “You’ll degrade yourself however you must to experience even a shred of what you once had,” writes Grisel. She’s known of more than one person who had his or her teeth removed, one at a time, to lay hands on bottles of opiates. More people die of narcotic overdoses than in car accidents.

As for the “sledgehammer,” aka alcohol, “social convention is pickled in the intoxicating juice of alcohol” and our society is in collective denial. Grisel writes that 700,000 students are assaulted annually by another student who’s been drinking. Drinking is condoned, encouraged and enabled at every turn. Excessive drinking is associated with a kind of torture chamber of physical ills, from strokes to heart attacks to a litany of cancers and organ diseases. The newest studies are grim, showing that even one drink a day can lead to a variety of cancers. “The more people drink,” says Grisel, “the worse the outcome.” Women crash more quickly because higher percentages of body fat mean less blood than men and, therefore, a slower metabolism of the toxic substance.

“So many of us are dying in plain sight as our neighbors, friends and co-workers carry on blithely.” In this collective, societal denial, she says, “no one is to blame, but we are all responsible.” She ponders why addicts mostly evoke revulsion, whereas those suffering other diseases evoke compassion. “Instead of wringing our hands, we might try holding one another’s.”Rae Padilla Francoeur can be reached at Rae@RaeFrancoeur.com.